ESTRO 2023 - Abstract Book

S1283

Digital Posters

ESTRO 2023

1 Vajira Hospital, Radiology, Bangkok, Thailand; 2 Sawanpracharak Hospital, Radiology, Nakhonsawan, Thailand

Purpose or Objective It is still controversial whether upfront systemic therapy without radiotherapy is safe for SVC syndrome in non-small cell lung cancer (NSCLC) patients. In addition, the benefit of steroids and diuretics is questionable until now. Therefore, relations between the treatments and survival need to be investigated. Materials and Methods Data of patients with SVC syndrome due to metastatic NSCLC, including age, sex, performance status, smoking status, histology, locations of distant metastases, previous treatments, SVC thrombosis, SVC syndrome grade, upfront treatment (radiotherapy versus systemic therapy), steroids, diuretics, intubation and anticoagulants as independent factors, were retrospectively collected. Associations between these variables and time to death were analyzed using the Cox proportional hazard regression. Results From January 2012 to August 2022, 80 patients who fitted study criteria were identified. The mean age was 60.2 year (SD 10.4). 85% were male and 67.5% had a history of smoking. Most patients had adenocarcinoma (49%). Visceral and bone metastases were found in 65% and 21.3%, respectively. Systemic treatment for metastatic disease was given in 28.7% of the patients prior to diagnosis of SVC syndrome. 20% had SVC thrombosis. There were 18 patients (22.5%) receiving systemic therapy as an upfront treatment for SVC syndrome. Steroids, diuretics, and anticoagulants were administered in 47.5%, 38.8% and 13.8%, consecutively. No significant independent factor was found in both univariable and multivariable analysis. Patients receiving upfront systemic treatment and radiotherapy had median overall survival (OS) of 34 and 57 days, respectively, while 1-year OS were 11.8% and 8.8%, consecutively. Both patients with and without steroids had a median OS of 35 days. 1-year OS were 5.6% and 13.2%, respectively. Median OS of ones who were administered with diuretics was 30 days, whereas 35 days was median OS of ones without diuretics. 1-year OS were 7.7% and 10.4%, consecutively. Conclusion Systemic treatment is safe as an upfront therapy for advanced stage NSCLC patients presenting with SVC syndrome. There is no benefit of steroids or diuretics in terms of survival in these patients. A. Zamagni 1 , G. Siepe 2 , M. Ferioli 3 , M. Buwenge 3,2 , M.C. Malato 3,2 , C. Gasperini 4 , G. Macchia 5 , F. Deodato 5,6 , S. Cilla 7 , L. Campanacci 8 , A. Bazzocchi 4 , S. Cammelli 2,3 , A.G. Morganti 2,3 1 Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy; 2 Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 3 Department of Experimental Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy; 4 Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; 5 Radiation Oncology Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; 6 Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy; 7 Medical Physics Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; 8 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy Purpose or Objective External beam radiotherapy (EBRT) is a well-established treatment option in the treatment of pain from bone metastases. However, not all patients (pts) experience pain relief after EBRT. Moreover, it can take up to six weeks before adequate pain relief is reached and approximately 50% of initial responders experience recurrent pain. Magnetic Resonance image guided High-Intensity Focused Ultrasound (MRgHIFU), as an alternative or in addition to EBRT, may improve pain palliation in these pts by increasing the percentage of responders and decreasing the time to response. However, large datasets on the feasibility of MRgHIFU are not available; therefore, the rate of pts who can benefit from this therapy is unclear. Therefore, this analysis aims to report the preliminary results of patients screened in a radiotherapy centre for inclusion in a randomized study of MRgHIFU versus EBRT versus MRgHIFU plus EBRT (The FURTHER-trial, H2020, NCT04307914). Materials and Methods The inclusion criteria of the trial were as follows: painful metastatic bone lesion (NRS ≥ 4), pain from target lesion distinguishable from other lesions, target lesion location is accessible for MRgHIFU and EBRT, pts able to fit in the MRI gantry, reasonable performance score (KPS ≥ 50%). Exclusion criteria were as follows: neurological symptoms due to nerve involvement of target lesion, previous surgery or need for surgery of targeted location due to pathological fracture, unavoidable critical structures in the target area, the curative intention of the treatment plan, and contraindications for MRI or sedation. Results From February 2021 to September 2022, 188 bone metastases (167 pts) were screened for inclusion and 186 lesions (98.9%) in 165 pts (98.8%) were considered not eligible for the trial for the following reasons: spine or skull lesions (96 lesions, 51.0%), NRS<4 or NRS=0 or non-distinguishable pain (38 lesions, 20.2%), target lesion non-accessible for MRgHIFU or MRI contraindications (31 lesions, 16.5%), previous surgery or pathological fractures (13 lesions, 6.9%), KPS < 50% (5 lesions, 2.7%), curative intent of EBRT (3 lesions, 1.6%). Conclusion MRgHIFU is a promising modality of palliation in pain from bone metastases, especially in pts with symptoms resistant to EBRT. However, the results of our analysis show that the percentage of pts enrolled in an MRgHIFU trial is only 1.2%, with PO-1581 Can MR-guided HIFU replace palliative radiotherapy in the treatment of painful bone metastases?